The veins are usually affected by serious changes during the pro gress of gout. The dilatation and varicosity of the veins iu the vicin ity of the inflamed joint have been already noted. Sometimes this condition persists in a greater or less degree after the termination of an attack, and tends to become permanent and to involve the majority of the vertical veins in the lower extremities. Besides growing vari cose, the veins are very liable to inflammation, which is developed during or after an articular crisis, or as the consequence of some trifling injury—like a bruise or a blow. Phlebitis of this character is often transient in its manifestations, progressing from one segment to another of the affected vein, and remaining nowhere fixed for any considerable time. In many cases, however, it pursues the course of an ordinary inflammation without any unusual peculiarities. Its recognition is easy when a superficial vein is involved, but when the deep veins, in the calf of the leg for example, are inflamed, the fact is made known by the existence of deep-seated pain along the track of the vessel, and by an oedematous condition of the limb. In one
notable fact gouty phlebitis differs from the ordinary form of the dis ease—in its tendency to relapse without apparent local cause. Some times the inflamed vein becomes permanently closed, causing persis tent oedema of the limb that is exaggerated by standing or walking; but usually there is more or less complete recovery. Occasionally, as in ordinary cases, embolic accidents occur, and fatal obstruction of a pulmonary vessel may follow the detachment of a fragment from the thrombotic plug.
The tendency to phlebitis is evidently hereditary in certain fami lies. In this respect it resembles the gouty diathesis, upon which in such cases it is undoubtedly dependent. Whenever, in comparatively youthful male subjects, the veins become inflamed without apparent cause, there is reason to suspect gouty antecedents and predisposi tions, and the line of investigation should, accordingly, be guided in that direction.